Abstract.A study was conducted in Lima, Peru to determine if patients with Strongyloides hyperinfection had human T cell lymphotropic virus type-1 (HTLV-I) infection. The study included patients with Strongyloides hyperinfection and a control group consisted of sex-and age-matched asymptomatic healthy individuals whose stools were negative for Strongyloides. A third group included patients with intestinal strongyloidiasis. Sera from each study subject were tested for HTLV-1/2I by an ELISA and Western blot. The HLTV-1 infection rates (85.7%, 18 of 21) were significantly (P Ͻ 0.001) associated with Strongyloides hyperinfection compared with the control group (4.7%, 1 of 21). The HTLV-1 rate (10%, 6 of 62) for patients with intestinal strongyloidiasis was significantly (P Ͻ 0.001) lower than patients with Strongyloides hyperinfection, but did not differ significantly (P Ͼ 0.05) from the control group. The association of HTLV-1 infection was observed among 17 of 19 patients more than 20 years of age and one of two younger patients. None had HTLV-2 infection. In conclusion, Strongyloides hyperinfection among Peruvian patients was highly associated with HTLV-1 infection.Strongyloides stercoralis is a soil-transmitted intestinal nematode that has been estimated to infect at least 60 million people, especially in tropical and subtropical regions.1 The parasite is unique among the parasitic nematodes because of its ability to multiply within the human host for many decades, with the potential to cause life-threatening disease in immunocompromised patients. The usual route of transmission is by penetration of the skin by filariform larvae (infectious form), following contact with contaminated soil. After migration through the lung, the larvae crawl over the glottis, and are then swallowed and develop to adults in the small bowel mucosa. The uncomplicated intestinal form of disease produces nonspecific abdominal symptoms with or without mild sporadic diarrhea. Many infected patients are completely asymptomatic. 2 However, an autoinfective cycle may develop in a proportion of untreated cases. In these cases, infectious filariform larvae develop in the intestines from rhabditiform larvae. Penetration of the colon or the anal skin by filariform larvae, and migration through lung allow reinfection of the same host. The autoinfective cycle, which usually results in a low-grade, chronic infection in immunocompetent hosts, is poorly understood 3 . A large number of cases of chronic, asymptomatic Strongyloides infections were reported among World War II in Southeast Asian prisoners of war and in refugees up to 40 years after leaving endemic regions. [4][5][6] In contrast to autoinfection, Strongyloides may produce a disseminated infection in immunocompromised hosts incapable of mounting an immune response against the parasite. Massive dissemination of invasive filariform larvae from the colon to the lung, liver, central nervous system, or kidney frequently results in a fatal outcome. Carriage by Strongyloides larvae of enterobacte...

Millions of low-income people in the world are affected by intestinal parasites. Inexpensive, simple, and effective techniques for diagnosis are necessary. The spontaneous sedimentation technique in tube (SSTT), for application in poor healthcare settings and under field-work conditions, was described 25 years ago in Peru by Tello. The advantages of the SSTT are its ability to detect the majority of intestinal parasites, including eggs, larvae, cysts, and trophozoites, and its low cost.

An observational descriptive study was conducted in a Shipibo-Conibo/Ese'Eja community of the rainforest in Peru to compare the Kato-Katz method and the spontaneous sedimentation in tube technique (SSTT) for the diagnosis of intestinal parasites as well as to report the prevalence of soil-transmitted helminth (STH) infections in this area. A total of 73 stool samples were collected and analysed by several parasitological techniques, including Kato-Katz, SSTT, modified Baermann technique (MBT), agar plate culture, Harada-Mori culture and the direct smear examination. Kato-Katz and SSTT had the same rate of detection for Ascaris lumbricoides (5%), Trichuris trichiura (5%), hookworm (14%) and Hymenolepis nana (26%). The detection rate for Strongyloides stercoralis larvae was 16% by SSTT and 0% by Kato-Katz, but 18% by agar plate culture and 16% by MBT. The SSTT also had the advantage of detecting multiple intestinal protozoa such as Blastocystis hominis (40%), Giardia intestinalis (29%) and Entamoeba histolytica/E. dispar (16%). The most common intestinal parasites found in this community were B. hominis, G. intestinalis, H. nana, S. stercoralis and hookworm. In conclusion, the SSTT is not inferior to Kato-Katz for the diagnosis of common STH infections but is largely superior for detecting intestinal protozoa and S. stercoralis larvae.

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We recommend that all patients with uncomplicated intestinal strongyloidiasis, who fail standard therapy, be studied for HTLV-I infection.